Abstract

Diagnosis of heart disease is often complicated by the fact that objective evidence of organic disease cannot be obtained. In many cases of coronary disease with angina pectoris, physical examination, roentgenographic representation of the size of the heart and cardiac pulsations, and electrocardiogram are normal. Patients with valvular disease often complain of symptoms such as dyspnea and pain when physical examination fails to reveal evidence of heart failure.

White1 states that in about one-fourth of all cases of angina pectoris, examination fails to reveal abnormality of the heart. Montgomery, Dry and Gage2 report that in a series of 405 patients